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This thesis focuses upon the practice and realities of 19th century rural medical practitioners located throughout segments of southwestern Virginia. The study particularly examines the career of Montgomery County physician Robert T. Ellett, M.D. Despite opening a practice located far from his family home, Ellettâ s medical career gradually thrived despite operating within an arduous social and geographic environment. Initially Ellettâ s entrance into Montgomery County society depended solely upon his elite stature and adherence to their established â common interests.â However, as time passed his identity became increasingly multidimensional. Ellett carefully crafted fruitful doctor/patient relationships by cautiously negotiating the domestic sphere. Patients and family members alike thought of Ellett as a healer and a â man of medicine.â Meanwhile, Ellett sustained the financial growth needed to support his large family by holding numerous local patronage positions. Ironically, while Ellettâ s domestic relationships constructed his professional identity, that role was preserved by constantly manipulating positions gained through that trust. Therefore, country physicians depended upon much more than personal character in building their practices. Instead, successful practitioners in similar social environments achieved stability by balancing a multidimensional identity that ultimately subscribed to both local and personal interests.